Conversation
Grand Rounds on the Intermediate Care Ward
of the Children’s Heart Center:
Conversations with Patients, Staff & Students

By Michele Frank, M.D.

MEDICC Review visited the Intermediate Care Ward of the Children’s Heart Center ward with Dr. Betancourt (see Interview: Dr Acelia Betancourt Pérez ), who invited us to participate in morning rounds. We joined a group of fourth-year medical students, residents training in pediatric cardiology, and other professional staff. As we walked from bed to bed, each patient was presented formally, the chart was reviewed and discussed, and the professor asked questions of the students and dialogued with the residents as well as the parents, both with regards to diagnostic issues as well as current status. The patients were all accompanied by at least one parent and the families shared food, while the children who felt well enough played with each other, excitedly awaiting the white-coated group as it approached each individual bed.

The medical student group included five Guatemalans who are studying medicine in Cuba as part of the Latin American Medical School Program ( ELAM according to its Spanish acronym). All are from underserved communities and villages, often in rural areas without access to medical services. These young physicians-to-be spoke about their plans to return to their home communities after graduation. According to one young woman, Alicia, she will be the first full-time Guatemalan physician to live and work in the village where she was raised. Another young man said he hoped to go back and work in the city even though his home was also in rural Guatemala. Both the Cuban and the Guatemalan students expressed surprise that the patients on the ward were from both nearby Havana and Havana province and also distant regions of Cuba, as far away as Moa [in Holguín Province], for example.

Dra. Acelia Betancourt, the professor leading rounds with medical students.

MR asked the residents about their studies, their clinical experience at this particular facility and their thoughts about the Children’s Heart Center. “I think we all benefit from the work here. We enjoy the studying and the time spent on the ward," said one. "The atmosphere is great – lots of energy, respect and human sensibility along with some very difficult medicine. It is so hard to see a child the day after heart surgery but so amazing to watch the kids when they are ready to leave…they’re not scared anymore and their families are so relieved. And ‘La Doctora Acelia’ is an inspiration, a tremendous teacher!” Some of the other students smiled, even laughed, and the resident went on to note that she was very demanding academically, “but she’s good people! - very kind - and pleasant to be around, so the time goes by fast.”

Stopping by the bed of three-year old Yanisbel Arias Sánchez, the professor explained that the child suffered from the condition called “Tetralogy of Fallot” with a Ventricular Septal Defect (VSD) and obstruction of right ventricular outflow with a right-to-left intra-cardiac shunt. This child and her mother, Eugenia Sánchez, had just arrived two days before from the Moa region of eastern Cuba. Small and thin, as is typical in children with this condition, Yanisbel was shy and clearly quite sick. She appeared to be a little frightened even, by all the attention from the group surrounding her bed. The professor, picking up on this perhaps, did not spend much time at this bedside, although she urged everyone to study up on Tetralogy of Fallot for discussion later in the week, assuring everyone as we moved on that this case would have a “happy ending.”

Yanisbel’s mother, Eugenia Sánchez, told us how Yanisbel had suffered “her first crisis in Moa: she had a kind of fit, she got a little bit aggressive and then she turned a sort of blue color and fainted, she had trouble breathing. They kept her at the polyclinic in Moa for five days.” This is a special polyclinic that has in-patient emergency services, beds - a community-based hospitalization program. “We didn’t know what was wrong, she was slow and skinny and didn’t grow much and then she would have these fits and fall down or get agitated. Then they sent us to the hospital in Holguín, where she had a CAT scan. They found a cerebral abscess and she had to have an operation. She was in that hospital for a month. But 10 days later, after we had left the hospital, she had another crisis and we went back to the hospital in Holguín and that’s when they decided that we should come here because she has a problem with her heart.”

Yanisbel was not much interested in interacting with us and she was clearly weak, awaiting surgery for her condition. Her mother Eugenia told MR that she hoped that with this operation now, everything would get better.

5-year old Edgar Cordiez and his Dad, Eduardo Cordiez, posing for MR during rounds.

Another patient on the ward was young Edgar Cordiez, an energetic, bright 5-year old who was undergoing a pre-operative diagnostic work-up for a congenital heart malformation diagnosed in infancy but managed without surgery until now. Edgar was accompanied by his father, Eduardo Cordiez, who explained that the anomaly “was picked up just days after he was born by the family doctor. She was worried about his irregular heart rhythms and I heard them too, so she referred us to a specialist at a nearby pediatric hospital. Now that Edgar is a bit older,” his father went on,“ he is stronger, he is having more tests and we think that he will have an operation here at this hospital so he can live a normal life.” Edgar played happily with his new friend and “neighbor,” another little boy in the next bed over, jumping between beds, playing and joking. Both boys were clear that they were going to have operations and were able to express their understanding that they had “heart problems.” Yet both seemed quite unconcerned, much more interested in the games they were inventing to fill their days.

We also spoke briefly with a mother pushing her daughter in a wheel chair on the way out to physical therapy, a day after open heart surgery. The 11-year old girl was feeling pretty down, she said, but her mother quickly chimed in that “of course! Who wouldn’t after all of that!” Dr. Betancourt added that she thought she was “amazing, a great patient and so impressive” for her rapid recovery. The girl was not interested in any of this and said she just wanted to go home - she missed her own bed, her friends, good food, she said.

Venezuelan mother, Isabel Sis, with baby Kelvin Navarro, in Cuba for medical treatment for a serious heart condition.

As rounds continued, we stopped to speak with a boy from Angola, Gildo Leopoldino Miguel, who was leaving the next day to go home to Africa, just in time for his second birthday. He had been in Cuba for more than a month with his father, Cristo Miguel, a nurse who had studied in Cuba some years before.

Cristo Miguel told us he missed his wife and the boy missed his mother, but he was the one who came because he spoke Spanish and knew a lot of people in Cuba since he had studied here. Gildo was clearly a ward favorite with the nurses and doctors, a charmer who was learning to say some words in Spanish and happy to pose for the camera with his favorite nurse and “La Doctora.”

“I don’t need to tell you how incredible this is,” Cristo Miguel said to MR. These things that they do here – you know, you are here. They save so many lives. I know you know this, but I have to say it again and again, anyway, Cuba is wonderful! And my boy is fine! Look at him!”

Finally, near the end of the visit, we spoke to a Venezuelan mother, Isabel Sis, as she held her two year old baby, Kelvin Navarro, in her arms. "This child was almost dead,” she said. “….Almost dead and I wanted to die, too. Now I think maybe we will get better. At least Kelvin is eating a little now and there are good doctors here. I have some hope now.”